a blog of books every doctor should read

Blink: The Power of Thinking without Thinking

Synopsis

In his second book, the author applies his characteristic style to explore intuitive judgments. Blink refers to the ‘small judgments and rapid cognition’ which ‘take place behind a locked door’ (page 51). He makes the case that these ‘decisions made very quickly can be every bit as good as decisions made cautiously and deliberately’ (page 14). The book covered fields as diverse as bird watching, basketball, the military, car salesmanship, and even speed dating (pages 43-45, 89 and 61). The author uses these to show that we use unconscious judgments all the time, saying ‘thin-slicing is not an esoteric gift. It is a central part of what it means to be human’ (page 43).

The book uses many stories and anecdotes to illustrate how Blink enables us to reach conclusions without our immediately realising this (page 10). An example is the story of the Greek sculpture acquired by the J Paul Getty Museum which was suspected to be a fake by the experts who did not rely on scientific tests but on subjective feelings such a ‘wave of intuitive repulsion’. Many stories involve people who have honed their thin slicing skills. An example is John Gottman who can predict couples likely to divorce just by observing a few seconds of their conversation, noting emotions such as stonewalling, defensiveness, criticism, and contempt (page 21). Another example is Wendy Levinson who can predict the likelihood of litigation against surgeons just by studying a snippet of their consultation, by gauging emotions such as warmth, hostility, dominance, and anxiousness (pages 21 and 42).

The author supports his arguments with established scientific observations. The author refers, for example, to the psychologists Gerd Gigerenzer on his concept of ‘fast and frugal‘ cognition (page 11), and Timothy Wilson on the adaptive unconscious (page 12). He cited Claude Steele and Joshua Aronson on stereotyping (page 56), John Bargh on priming (page 53), Jonathan Schooler on verbal overshadowing (page 119), and Silvan Tomkins, Paul Ekman, and Wallace Friesen on recognition of facial emotions within the context of the Facial Action Coding System (page 204).

Many parts of the book refer directly to medical practice. The author referred, for example, to the fast and frugal heart attack decision tree developed by the cardiologist Lee Goldman (page 134). He discussed mind-reading failures with reference to the work of Simon Baron-Cohen on autism (214), and the anatomical correlates of unconscious decision-making, citing the neurologist Antonio Damasio on (page 59-60).

Although the book is full of praise for intuitive judgments, it stresses their significant limitations. The author refers to these as ‘the dark side of thin-slicing‘ (page 75). He points out that ‘snap judgments and first impressions’ are most effective for ‘high stakes, fast-moving situations‘, but are prone to error when applied in circumstances requiring rational decision making. He illustrated this with several examples such as the Warren Harding error, the election of one of the worst American Presidents because people relied on subconscious bias, an error that is ‘at the root of a good deal of prejudice and discrimination‘ (page 76). Other limits of thin-slicing include situations requiring repeated exposure, and the author illustrated with the stories of the musician Kenna (page 147), and of the Aeron chair (page 167).

Can we learn to control our intuition to avoid making wrong judgments? The author believes this is feasible with techniques such as changing first impressions (page 97), preparing for situations that require rapid judgments (page 99), and limiting our choices (page 143). He also emphasised the importance of becoming aware of subconscious bias, exploring bias detecting tests such as the Implicit Association Test developed by Anthony Greenwald, Mahzarin Banaji, and Brian Nosek (page 77).

Opinion

The book highlights the importance of intuitive decision-making, exploring its advantages and limitations. In doing so, the author discusses cogent psychological concepts, illustrating them with excellent stories and applying an unassailable writing style. The author, a journalist, personally interviewed many of the people he discussed, and this imparts authenticity to the stories the book relies on. The subject of the intuitive judgments is as relevant to mundane social interactions as it is to high stake judgments, and this well-researched book has done an excellent job of bringing it life.

Overall assessment

This book illustrates the importance of intuitive decision-making, a subject that is directly relevant to medical practice. The author has addressed most facets of this topic, and I recommend it to all doctors.